A Comparative Study Of Antiplatelet Treatment Perscription After Extracranial Carotid Artery Stenting

Background: Endovascular stenting has become an important measure for the prevention and treatment of ischemic stroke,but less study of contrast with long-term antiplatelet therapy effect of aspirin or clopidogrel separately after extracranial carotid artery stenting,and different Essen score groups after stenting of two kinds of antiplatelet drug effect was rarely reported.Objective: To compare the adverse endpoint event rates of asprin or clopidogrel separately after the extracranial carotid artery stenting during one-year follow-up and the differences of two kinds of antiplatelet drugs in different Essen score groups.Methods: Between January 2014 to January 2015,a total of 219 current ischemic stroke patients who underwent the extracranial carotid artery stenting in the First Affiliated Hospital of Chongqing Medical University and the Affiliated Xinqiao hospital of Third Military Medical University were enrolled,all of them would take dual antiplatelet therapy(aspirin 100mg/d and clopidogrel 75mg/d),combined with 1 month(69 cases),combined with 3 months(150 cases),and then take aspirin(124 cases)100mg/d or clopidogrel(95 cases)75mg/d separately.Essen score of enrolled patients,divided into low risk group(41 cases)and high risk group(178 cases).The primary endpoint of the study was(ipsilateral cerebral infarction,non-ipsilateral cerebral infarction,myocardial infarction and death)and the secondary endpoint was(intracranial hemorrhage or extracranial hemorrhage)at one-year follow-up.Results: The baseline characteristics between aspirin group and clopidogrel group was comparable.At one-year follow-up,no significant difference existed in ipsilateral cerebral infarction(2.4% vs 1.1%),non-ipsilateral cerebral infarction(0.8% vs 0.0%),myocardial infarction(0.8% vs 0.0%)and death rate(0.0% vs 0.0%,P>0.05),as well as in the composite of primary endpoint(4.0% vs 1.1%)between the two groups.Also,no significant difference existed in intracranial hemorrhage(1.6% vs 1.1%),extracranial hemorrhage rate(3.2% vs 1.1%,P>0.05),as well as in the composite of secondary endpoint(4.8% vs 2.2%)between the two groups.The low-risk group of Essen score showed no significant difference in ipsilateral cerebral infarction(4.3% vs 0.0%),non-ipsilateral cerebral infarction(0.0% vs 0.0%),myocardial infarction(0.0% vs 0.0%)and death rate(0.0% vs 0.0%,P>0.05),as well as in the composite of primary endpoint(4.3% vs 0.0%)between aspirin group and clopidogrel group.Also,the high-risk group of Essen score showed no significant difference in ipsilateral cerebral infarction(2.0% vs 1.3%),non-ipsilateral cerebral infarction(1.0% vs 0.0%),myocardial infarction(1.0% vs 0.0%)and death rate(0% vs 0%,P>0.05),as well as in the composite of primary endpoint(4.0% vs 1.3%)between aspirin group and clopidogrel group.Conclusions: There was no significant difference on the primary endpoint and secondary endpoint event after taking aspirin or clopidogrel separately for one year after the extracranial carotid artery stenting and subsequently dual antiplatelet therapy for one or three months.Also,no significant difference in the primary endpoint of the two antiplatelet agents in different Essen score groups.Need larger sample for further research.